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test 2 > Nutritional Considerations > Flashcards

Nutritional Considerations Flashcards

1
Q

Serum albumin lab levels

A

3.5 to 5.4 G/dL

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2
Q

Prealbumin lab levels

A

15to 35 g/ dL

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3
Q

The most sensitive indicator of protein malnutrition.

A

Prealbumin

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4
Q

Transferrin lab level

A

Greater than 200mg/ dL is normal

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5
Q

Serum protein that binds and transfers iron

A

Transferrin

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6
Q

Predictor of protein depletion when less than 200mg/dL

A

Transferrin

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7
Q

Nutrition lab levels Total lymphocytes count

A

1 to 3 x10(9)/L

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8
Q

Lab hydration marker bun/creatinine normal levels

A

Less than 20

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9
Q

Normal serum osmolality lab levels

A

275-295 mmol/ kg

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10
Q

Obese 400lb man lost 40 lbs in the last 6months due to starvation, before beginning refeeding what would be considered

A

Watch for refeeding syndrome the body can start using glycogen from the over during times of starvation. If food is reintroduced to fast the body will have insulin spike causing k/mg/p to be taken up into cells, depleting the system leading to adverse effects. Possibly death.

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11
Q

If patient is unable to take food by mouth when would you use enterstomal tube

A

needs supplement greater than 6 weeks

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12
Q

If patient is unable to take food by mouth what would you use if there is a risk for aspiration

A

Duodenal tube

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13
Q

In elderly when could you use mirtazipine for nutrition

A

patient is malnurished and depressed

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14
Q

When is it practical to use TPN

A

When GI tract is not usable parenteral nutrition is needed

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15
Q

why is megestrol not suggested for nutrition in elderaly

A

Beers list and risk of thrombotic event maybe death

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16
Q

Gastromy feedings PEGS CAN BE USE FOR how many weeks

A

great than 4 weeks

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17
Q

hallmark refeeding syndrome can cause what kind of shift in labs

A

hypophosphatemia, hypomagnesemia,

hypokalemia, and thiamine deficiency

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18
Q

Patient was on enteral feedings for several weeks what is the syndrome to watch for when started to refeeding

A

re-feeding syndrome

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19
Q

When some one has hadno or limited nutritional intake fr more than 5 days how should someone be feed to prevent refeeding dsyndrome

A

10kcal/kg perday slowly increase over days

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20
Q

Before correcting feeding for someone malnurished you should correct what

A

Fluid and electrolyte

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21
Q

Diagnosis of cachexia & malnutrition

A

BMI < 18.5 with unintentional weight loss >10% within
3-6 months
Limited or no nutritional intake for more than 5 days

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22
Q

Complications
of Parenteral
Nutrition

A 
Occurs in approximately 50% of patients
 Pneumothorax
 Arterial laceration
 Air emboli
 Catheter thrombosis
 Catheter sepsis
 Hyperglycemia
 HHNK
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23
Q

Palliative
Care and
Enteral
Feeding considerations

A

Consider family and patient’s wishes
 Obtain swallow test
 Feed for pleasure

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24
Q

Essential diagnosis of Anorexia nervosa

A

female with 3 consecutive missed menses
body image disturbance
weight loss leaving body wt 15% less than expected

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25
Q

Female patient with bradycardia, hypotension, with complaints of being cold and constipated and amenorrhea. patient looks emaciated you suspect and labs look like

A 
anorexia nervosa
cbc> anemia an d leukopeia
chemistry> electrolyte abnormals
BUN> elevated
creatinine> elevated
Serum cholesterol> incresed
FSH > low
Luteinizing Hormone> low
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26
Q

Treatment goal of anorexia nervosa

A

restore normal weight and body image (2/3 success)

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27
Q

essentials of bulimia nervosa diagnosis

A

binge eatting twice weekly for 3 months
self induced vomiting, laxitives, diuretics, fasting, over exercise
overconcern with weight and shape

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28
Q

female patient healthy looking with complaint of sorethroat; states normal menses, on exam you see inflammation of throat and poor dentation; what would you ask and suspect

A

have you had any diet changes, fluctuations in weight. Labs may show abnormalities
suspect bulimia

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29
Q

Plan of care for some one with bulimia

A

educate on nutrition
start on ssri
refer to psych

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30
Q

What is wet beriberi

A

seen in thiamine (B1) deficiency
due to high physical exertion and increased carbs
effects cardiovascular system
causes peripheral vasodilation, edema, warm extremities mimic cellulitis
also
tachycardia with High output heart failure =>pulmonary edema => dyspnea,

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31
Q

Dry beriberi

A

seen in thiamine B1 deficiency
affects central and peripheral systems
leading to neuropathy lower > upper
and wernicke-korsakoff

32
Q

Treatment of thiamine deficiency

A

3 days 50 to 100mg/day thiamine IV, then 5 to 10mg qd

33
Q

Treatment of thiamine toxicity

A

thiamine does not cause toxicity

34
Q

Riboflavin deficiency treatment

A

meat fish dairy

35
Q

Niacin deficiency presents as? can diagnose by

A

Pellgra: dementia, diarrhea, dermatitis

Urine screen for Niacin metabolites show low niacin

36
Q

Vitamin B deficiencies can present with symptoms of

A

irritability, weakness, mouth sorness, glossitis, and cheilosis (red corner of mouth)

37
Q

Treatment of pyridoxine (B6) deficiency? isoniazid?

A

supplement 10-20mg/d

Isoniazid (lowers B6) suppliment b6 50-100mg/day

38
Q

Pyridoxine toxcitiy

A

seen in high doses 200-2000mg/d causes neuropathy

39
Q

Vitamin C toxicity

A

gastric irritation, diarrhea
kidney stones
high dose causes false stool and urine test

40
Q

A patient with postop ileus, gastroenteritis, or paritial instestinal obstruction would need what type diet

A

clear liquid diet

41
Q

What is a clear liquid diet

A

provide adequate fluids and 500 to 1000kcal

42
Q

what is full liquid diet

A

low residue diet

clear liquid diet with added dairy, soft foods like cereal or eggs

43
Q

Patient with difficulty chewing but has no GI issues should be placed on what type diet

A

soft diet

44
Q 
which is a food that represents a soft diet
Raw vegetables
raw fruit 
course bread 
tender foods
A

tender foods

45
Q

what effect will low sodium diet have on diuretic therapy

A

use less diuretic medication, decrease potassium loss

46
Q

patient with complaints of diarrhea and steatorrhea,what may be cause, suggest what type of diet

A

cause maybe due to fat malabsorption, suggest fat restricted diet

47
Q

Patient with diagnosed hepatic encephalopathy due to chronic liver disease required what type diet

A

protein restricted diet 0.6g/kg/d

48
Q

How to estimate water requirements for patients

A

1500ml for the first 20kg of body weight plus 20ml for every kg above the first 20kg

49
Q

Complication from using parenteral nutrition: Hyperglycermia? How to treat

A

caused byparenteral infusion of dextrose too fast, also stress, or corticosteroids
Treat: decrease glucose infusion, insulin, replace dextrose with fat

50
Q

Complication from using parenteral nutrition:

Hyperosmoar nonketotic dehdration, Treat?

A

caused by severe, undetected hyperglycemia,

Treat: insulin, hydration, postassium

51
Q

Complication from using parenteral nutrition:

hyperchloremic metabolic acidosis? Treat?

A

caused by Due to high chloride administration

Treat: decrease chloride

52
Q

Complication from using parenteral nutrition: Azotemia, Treat?

A

caused by high protein content, decrease protein

53
Q

Complication from using parenteral nutrition: hypophosphotemia, hypokalemia, hypomagnesiemia

A

caused by Extracelluar to intracellular shift due to refeeding syndrome,
Treat by increasing solution concentration

54
Q

Complication from using parenteral nutrition: Liver enzyme abnormalities, Treat?

A

caused by Lipid trapping in hepatocyctes,

Treat: Decrease dextrose

55
Q

Complication from using parenteral nutrition: Acalculous cholecytitis, Treat?

A

caused by billiary stasis,

Treat: with oral fat

56
Q

Complication from using parenteral nutrition:

Zinc defciency, Treat?

A

caused by diarrhea, small bowel fistulas.

Treat: increase concentration

57
Q

Complication from using parenteral nutrition: Copper deficiency

A

caused by billiary fistula, treat with increased concentration

58
Q

When parenteral nutrion is used metabolic complicatoins should be monitored how often,

A

Electrolytes daily until balanced, then monitor twice weekly with RBC, folate, copper, and zinc monthly

59
Q

When should central vein nutritional support be considered

A

1) Gastrointestinal tract can not be used, and
2) support is needed for longer than 2 to 3 weeks
3) peripheral veins cant tolerate

60
Q

When can peripheral vein be used for parenteral nutrition

A

when vein placement is adequate and fluid tolerance is good

61
Q

When should enterostomy tube be placed for nutritional support

A

When patient GI tract can be used safely and effectively and support is needed longer than 6 weeks

62
Q

When should nasoduodenal tube be used for patient

A

patients GI tract is safe and effective

patient not at high aspiration risk

63
Q

Difference between DKA and HHNK

A

DKA usually seen in type 1, ketoacidosis is seen

HHNK seen in type 2 DM, no ketoacidosis

64
Q

DASH diet stands for? used commonly for people with?

A

Dietary Approaches to Stop Hypertension

Hypertension

65
Q

Female using oral contraceptive or hormone replacement therapy can effect what serum protein

A

transferrin

66
Q

Serum osmolality normal levels

A

280 to 300 mmol/kg

67
Q

Serum sodium normal level

A

< 150mEq/L

68
Q

Urine specific gravity normal level

A

1.005 to 1.030

69
Q

Urine volume normal level

A

> 1200mL/ day

70
Q

what albumin level indicates malnutritoin

A

<3.5g/dL

71
Q

Malnutrition with edema may have albumin level of

A

<2.7g/dL

72
Q

Hemoglobin of <12g/dL for women by indicate

A

lack of iron

73
Q

Parenteral nutrition needed for more months or years used what type of access

A

tunneled catheter or port

74
Q

What are 4 complications of Parenteral nutrition

A 
Occurs in approximately 50% of patients
 Pneumothorax
 Arterial laceration
 Air emboli
 Catheter thrombosis
 Catheter sepsis
 Hyperglycemia
 HHNK
75
Q

What are 4 complications of Enteral nutrition

A 
Aspiration
 Diarrhea
 Emesis
 GI bleeding
 Mechanical obstruction
 Hypernatremia
 Dehydration
 Re-feeding syndrome

test 2 (13 decks)

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